Migraines

The Basics of Migraines

Migraine headache causes intense throbbing or pulsing pain in one area of the head. This type of headache is usually accompanied by nausea, vomiting, and sensitivity to sound and light. Migraine attacks often lead to pain that persists for hours and even days. Some migraine patients experience aura, which is sensory warning symptoms that occur immediately before the onset of pain. These symptoms include blind spots, flashes of light, and/or tingling sensations of the arm and/or leg.

In the U.S., more than 30 million people report one or more migraine headaches per year. Females suffer with migraines more than males, with a rate of 18% for women compared to 6% for men. In addition, migraine appears to affect whites more than African Americans and Asian Americans. According to the World Health Organization, global prevalence of migraine is around 10%, with higher rates occurring in North America.

Symptoms of Migraine Headache

Symptoms are broken down into four categories, which occur in phases: prodrome, aura, attack, and postdrome.

Prodrome – These occur one or two days before the migraine and include irritability, constipation, depression, hyperactivity, food cravings, yawning, and neck stiffness.

Aura – These include vision loss, visual phenomena, speech problems, and tingling of the arm or leg.

Attack – This involves the actual pain, which can last from 4 to 72 hours. Symptoms include pulsating/throbbing pain on one or both sides of the head, sensitivity to light and sound, blurred vision, nausea, vomiting, lightheadedness, and/or fainting.

The exact cause of migraine is not known, but experts believe these headaches are related to changes in the brainstem and interaction of the brainstem with the trigeminal nerve. In addition, there is often an imbalance of serotonin, which is the brain chemical that regulates pain in the nervous system.

Migraine Triggers

Several things appear to trigger the onset of a migraine headache. These triggers vary from patient to patient and include:

Hormonal changes – Fluctuations in estrogen, with women reporting headaches right before or during the menstrual period. Some women have migraines during pregnancy or menopause. Additionally, oral contraceptives and hormone replacement therapy often worsen migraines.

There is no cure for migraine headaches for people who suffer with them chronically. The goal of treatment is to reduce the frequency of the headaches and to alleviate symptoms. The types of medicines used include:

Preventive medicine – These drugs prevent the occurrence of the migraine headaches.

Pain medicine – These drugs eliminate or reduce pain when a migraine occurs.

Migraine medicine – These drugs prevent the migraine if taken as soon as the headache begins.

Occipital nerve blocks – A nerve block is the injection of an anesthetic and steroid medication into the posterior region of the mouth, as the base of the nerve. These injections result in immediate relief of pain and can be performed two times a week for three weeks.

Sphenopalatine ganglion block – This involves an injection done through a catheter, which is inserted into the nose. The medication is inserted into the region of the sphenopalatine ganglion, which is a group of nerves.

Trigger point injections – To reduce the pain associated with migraine, an injection of an anesthetic is given into the facial fascia, the soft connective tissue that surrounds the muscle. This injection is safe and effective.

Botox – This medication has been approved for the treatment of chronic migraines. The injections are given to the forehead and temple region to paralyze the muscles which contract and are associated with migraine.